| NPI | 1528486628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.013983) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: OH 34.013983) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2026-05-27 |